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Obamacare: An Analysis

DrNoIntroduction

I’m fifty-six and most of my life I have been unconcerned with medical issues because of good health.  I was a jock, was never seriously injured and took my health for granted.  During the summer of 2007 I began to get weary and put on weight, so I eventually went to the hospital.  l was immediately admitted and diagnosed with genetically-caused liver failure.  In September 2007 I was admitted to the Cleveland Clinic and in November I had a liver transplant.   Over the five months in the Clinic, I incurred four major infections including E-coli, MRSA Staff, C-diff, and Pseudomonas along with Pneumonia.  I was on dialysis, had a heart attack, had a major internal bleed, suffered blood clots including one which has left me permanently blind in my right eye and was reduced to 120 pounds.

Our first hospital bill was for nearly half a million dollars and total costs for my care and expenses came closer to a million than half a million dollars. Needless to say, I am now extremely interested in health care issues and medical costs. I have excellent medical insurance through my job but had not paid close attention to the details of the coverage for years, though I knew I had pretty good coverage.  Fortunately nearly all of my bills were covered by this insurance and payment of the nearly ten thousand in expenses not covered by my insurance was generously assisted by friends in Ashland, the Ashland University community, and my Providence Church family.

This personal medical crisis motivated me to read the entire House of Representatives thousand plus page health care bill proposal.  I’d heard and read numerous analyses, both pro and con, by medical professionals, journalists, and Congressmen, but I needed to see for myself.  The following are some of my impressions of the bill.

The Proposed Health Care Bill

This bill is lengthy and boring with technical language making it extremely difficult to follow especially if one is not versed in the legal nuances of Medicare, Medicaid, and Social Security.  I’m a professional philosopher with the skill to decipher challenging reading, but this bill makes Aristotle and Kant look like a piece of cake.  It will take bureaucrats years to explain and apply the intricacies of this bill and I doubt if more than a few Congressmen could even follow the train of thought.

The bill causes one to realize that we already have a large government controlled health care program called Medicare.  The majority of this new bill is amendments to Medicare leading to a major expansion and overhaul of its system.

One of the legitimate roles of government is to protect its citizens.  All I want from government is for it to protect me from those who might rip me off.   This bill has elements which fulfill that function.  It protects whistleblowers who report abuses of the system.  It attempts to bring justice by reducing disparities in already established government health care including racial, ethnic, and geographic disparities.  It provides translators to communicate about health services for those citizens (and for noncitizens) with poor English.  It reduces paper-tracking by creating standardized electronic administrative transactions.

The bill is concerned about improper relationships between physicians and distributors of covered drugs.  To reduce fraud there is close monitoring of physician owned hospitals.  This overhaul includes revising rebates for prescription drugs.  It increases inspection reports on nursing homes and more safeguards on hospice programs.  It sets up a consumer website and an improved complaint process that should improve quality control.  It enforces repayments of Medicare overpayments.  Many of these seem to be protections for the patient and society which are good.  Yet it fails to address the central issues about these programs; they are under federal management and are running out of money.  Remarkably the new bill only adds to their problems by allocating more centralized authority and more money to broke programs.

Therefore, one should be skeptical whether a government run system (Medicare, Medicaid, and Social Security) that is going broke should be the model and foundation for a new expanded societal-wide program.  Their economic failure should warn us about the dangers of combining government and health care.

Ten Important Observations

Below are ten major observations I have:

  1. The striking realization that most comes to mind when reading this bill is the massive allocations of funds to all of the new bureaucratic layers and innovations this bill sets up.  This bill allocates billions of dollars, but there is little said about gathering funding for all these projects.  The only mention of funding is the new 1% tax on those making 350,000-500,000, 1.5% for 500,000 to 1 million, and above 1 million is 5.4%.  This whole process seems forced down our throats without any thorough-going cost analysis or plan.

  2. I appreciated and loved my doctors at the Cleveland Clinic and most of them were international.  My lead transplant surgeons were Italian and Irish assisted by fellows who were Malaysian and Japanese.  My hepatologist is Lebanese and nephrologist is Indian.  They are all world class, brilliant, and great communicators.  Why are they all practicing in the United States?  I am sure there are numerous reasons such as great hospitals, fantastic training and research facilities, a wide-range of opportunities including freedom to practice their specialties in the best health care system in the world and make excellent salaries.  I am afraid that if we cap salaries, establish fee limits as in Social Security and Medicare, and alter the system then these fantastic doctors will no longer want to practice medicine in the U.S.  They will have better options in other locations and our health care will suffer.

  3. It allows the private insurance companies to continue in business but they must comply to the regulations and standards set upon them by the government as they must submit to health coverage participation requirements.  This will restrict freedom and the free market.  The next three points expose some of the new regulatory structure.

  4. The role of Secretary of Health and Human Services will be greatly increased, becoming one of the most powerful domestic cabinet positions.  This position will have unbridled power to establish medical and health policy.  Some of the responsibilities of this office will be to control billions of dollars of allocations, provide lists of public health options, exclude certain providers from participation, exercise regulatory power as necessary, determine criteria for quality of care, oversee nursing home care, identify services which are misvalued using specific criteria they create, oversee state loans for medical education and establish a Public Health Workforce Corps along with a means of distributing these people through the country.

  5. Page 41 says, “There is hereby established a Health Choices Commissioner…who shall be appointed by the President by and with the advice and consent of the Senate” (though it does not say confirmation).   Some of the responsibilities of this Commissioner will be data collection, audits, establish uniform standards for insurance, and oversee exchange of programs.   The Commissioner will appoint an ombudsman to deal with complaints and grievances.  This Commissioner may terminate contracts and determine affordability credit eligibility.  The Commissioner will determine whether the person is Medicaid eligible, determine the income based tiered limits of funding, shall specify the cost sharing reduction in cost sharing reduction amounts, be able to determine the cost effectiveness of various health procedures, and adjust the cost of living to reflect geographic differences.  The Commissioner shall establish uniform marketing standards all ensured Quality Health Benefit Plans shall meet and establish the process for review of denied claims.  In summary this person will have the authority to reframe the private and public options.

  6. A Health Care Benefits Advisory Committee will be established and chaired by the Surgeon General.  It will recommend covered benefits for each essential, enhanced, and premium plan.  It is composed of nine who are not federal employees and appointed by the President and nine who are not federal employees who are appointed by the Comptroller General .  They will recommend initial benefits standards, including covered treatments and levels of cost sharing and give recommendations to the Secretary.

  7. Pages 769-770 speak about family planning and who qualifies.  Nothing is mentioned directly about abortion.  Since the Hyde Amendment passed in 1976 federally funded abortions have been excluded in America, however, this new bill will trump the Hyde Amendment and if the Secretary of Health and Human Services includes abortion as part of covered health care then funded abortions will again return.  If this remains in a passed bill, true pro-life supporters may need to consider civil disobedience and withhold their taxes.

  8. Advanced care planning is advocated which will include Living Wills, end of life services being explained by a practitioner, and counseling a person whether to permit life sustaining treatment, including use of antibiotics, hydration, and nutrition.  Every five years a counselor will reevaluate a person’s choices.  End of life care options will be included in the “Medicare and You” booklet Handbook.  This opens the door for counseling in the direction of euthanasia and  pressure on the elderly and infirm to equate value of life with quality of life.

  9. There is no doubt with this new massive intrastructure and funding for a public health option it will crowd out choice and the private options.  This will remove the power to make decisions about health care out of our hands.  With that development health care will certainly be rationed.  Of course health care is already rationed through Medicare which consumer reporter John Stossel calls a “Ponzi Scheme.”  Paternalism will replace liberty.  Does it make sense to allow government control through this Commissioner when we have given government oversight to Medicare, Medicaid, and Social Security and all these programs are either broke or going broke?  Is there any rational basis to trust government with this responsibility?

  10. The first nine points are significant but the most fundamental unearthing is the quantity of power placed not only in the hands of government but specifically in the hands of the executive branch of government.  The President is given authority to appoint a Commissioner of Health care.  In conjunction with the Secretary of Health and Human Services, this person is given oversight, with a board, over the whole health area.  In other words, they have governance over 1/6th of the American economy under the directive of the President where there is no congressional oversight but only accountable to the President.  Not only is there a socialization of healthcare, but this places another large percentage of the economy directly in the executive branch of government.

Further Questions

There are sections of this bill which leave me with more questions than answers. What do they mean by a heath care excise tax on those employers who refuse to offer benefits?  Why is there a separate section specifically on California?  What are the implications of creating a National Health Care Work Force or National Health Service Corps?  Is this Corps only for those who have obligated service as the repayment for a government loan for medical education?  What will the effects of the bill be on MEDICARE ADVANTAGE?  How will they actually compute quality of performance?  What is a Telehealth Advisory Committee?  What really will Medicare and Medicaid look like after all of this restructuring?

Near the end of the bill there is an Advisory Committee on Health Workforce Evaluation and Assessment, how will this affect businesses and what power will they have other than the allocation of funds?  What is meant on p. 859 when it speaks of 600 million for medical prevention and wellness and how is this included in the Cap and Trade bill (p. 815)?   What will be the government philosophy in the school based health clinics?  Though I am sympathetic  to incentives for those who work as health care providers in underserved areas is this a legitimate role for government to give these incentives?  On p. 407 there are grants to those providers of services who are community organizers, would this be for ACORN and like organizations? Please spell out more clearly what is meant on p. 589 where civil monetary limitations are determined by the Secretary of Health and Human Services.  What is the Health Care Comparative Effectiveness Research Trust Fund and its ability to disperse 90 million dollars and increasing each successive year ?

Conclusion

I watched the Obama press conference on the health bill.   It was one of the most boring hours of television I’ve ever watched.  The president’s answers were obfuscated.  I kept asking myself, “what does this do for me and my family?” but he never answered this question.  I learned nothing, except the President has not read the bill.  He was often incoherent, answering a single question with five minutes of blather.  I don’t think he understands the basics.  All he cares about is the transfer of power from the people to the government.  Even Palin’s resignation speech looked like a coherent speech in comparison.  Now I know why.  He doesn’t understand the bill…all he understands is the desire for government control and oversight.

During the ’08 campaign I heard Obama referred to as a socialist by a McCain supporter.  McCain was supporting socialist ideas as well, especially in his support of Bush’s bailouts of the banking industry.  The more accurate term that came to my mind while reading this document was Totalitarianism.  Totalitarianism is “a society in which the ideology of the state has influence, if not power, over most of its citizens.”    This is exactly what we see happening.   According to Karl Loewenstein, a totalitarian regime “attempts to mold the private life, soul, and morals of citizens into a dominant ideology.  The… ideology penetrates into every nook and cranny of society” (Wikipedia).   Totalitarian states tend to condemn and silence outsiders; they attempt to establish control over their subjects and are often lead by a charismatic leader.  Those who passively submit to Totalitarianism seem to be willing to sacrifice freedom for security.

During the campaign for the presidency, candidate Obama adamantly stated that the Bush administration was guilty of centralizing power in the executive branch of the government.  This was an accurate and astute observation and evaluation.  He went on to add that one of the changes he would make would be to alter this development.  The hypocrisy is that as president, Obama has rapidly and intensively increased this trend through the bailout of banks, through the stimulation package, the takeover of the auto industry, the cap and trade bill, and the appointment of czars unaccountable to Congress.   These will be dwarfed by the passage of this proposed Health Care Bill.   One sixth of the economy will come directly under the auspices of the Executive Branch of Government, the Presidency.  Will you sit back and idly watch as freedom is sacrificed for the appearance of security?

Dr. Mark Hamilton, Associate Professor of Philosophy, Ashland University, Board Chairman of the Institute for Principled Policy

Posted in Commentary, Economics, Public Policy Principles News, Public Policy Radar, Taxation.


One Response

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  1. PARoss says

    Mark,

    Thanks for your time and effort. Your explanation is the most solid one I’ve heard. I watch the New Hour and the talking heads expound the need and benefits of reform, and to talk radio, which exposes the faulty foundations.

    My fear and expectation is that something will pass, and it won’t work very well — and it will cost more money that can be printed. It seems to me that the intention of this and the bail outs and the wars is to break the economy so that it can be fixed. I know it’s broken and that it needs to be fixed. But how can we trust those who break it to fix it?

    Trust is the underlying issue. Not who do we trust — it’s not a popularity game, but who can be trusted? The economists say that we need confidence in the market. But another name for trusting economic schemes is “con.” I’ve never felt more conned.

    Phil